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. 2021 Jan 5:6:11.
doi: 10.21037/tgh.2020.01.06. eCollection 2021.

Comparison between Milan and UCSF criteria for liver transplantation in patients with hepatocellular carcinoma: a systematic review and meta-analysis

Jorge Henrique Bento de Sousa  1 , Igor Lepski Calil  1 , Francisco Tustumi  2 , Douglas da Cunha Khalil  1 , Guilherme Eduardo Gonçalves Felga  1 , Rafael Antonio de Arruda Pecora  1 , Marcio Dias de Almeida  1
Affiliations

Comparison between Milan and UCSF criteria for liver transplantation in patients with hepatocellular carcinoma: a systematic review and meta-analysis

Jorge Henrique Bento de Sousa et al. Transl Gastroenterol Hepatol. .

Abstract

Background: Liver transplantation is the main treatment for hepatocellular carcinoma (HCC). However, because of the limited supply of transplant organs, it is necessary to adopt a criterion that selects patients who will achieve adequate survival after transplantation. The aim of this review is to compare the two main staging criteria of HCC for the indication of liver transplantation (Milan and UCSF) and to analyze the post-transplantation survival rate at 1, 3 and 5 years.

Methods: This is a systematic review and meta-analysis in which scientific articles from 5 databases (PubMed, Lilacs, Embase, Central, and Cinahl) were analyzed. The studies included in the review consisted of liver transplantation in patients with HCC in different subgroups according to donor type (deceased × living), population (eastern × western) and tumor evaluation (radiological × pathological) and adopted the Milan or UCSF criteria for the indication of the procedure.

Results: There was no significant difference between the Milan and UCSF criteria in the overall survival rate at 1, 3 or 5 years, and the overall estimated value found was 1.03 [0.90, 1.17] at 1 year, 1.06 [0.96, 1.16] at 3 years and 1.04 [0.96, 1.12] at 5 years. Regarding the analysis of the subgroups, no significant difference was observed in any of the subgroups with a follow-up of 1, 3 or 5 years.

Conclusions: Both the Milan and UCSF criteria have equivalent survival rate. Thus, less restrictive method would not result in a great loss in the final overall survival rate and would benefit a greater number of patients.

Keywords: Hepatocellular carcinoma (HCC); liver diseases; liver transplantation.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tgh.2020.01.06). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Selection of articles from databases. The 21 eligible articles included a total of 5,569 patients. Articles with topics not relevant to the Milan and UCSF criteria, articles with incomplete data and articles with populations already studied in other articles were excluded.
Figure 2
Figure 2
Comparison of global survival rates. The analysis of the overall survival rate between the different criteria (Milan and UCSF) did not identify significant differences at 1, 3 or 5 years in the included studies.
See this image and copyright information in PMC

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